Basic Information
| Provider Information | |||||||||
| NPI: | 1063462844 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VALENCIA | ||||||||
| FirstName: | MARIA LUZ | ||||||||
| MiddleName: | BERNABE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 BROKEN SOUND PKWY NW | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334873507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612419300 | ||||||||
| FaxNumber: | 5616583992 | ||||||||
| Practice Location | |||||||||
| Address1: | 15127 JOG RD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334461251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614956300 | ||||||||
| FaxNumber: | 5614958877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PT9466 | FL | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | BOARD OF PHY THER | 01 | FL | CERTIFICATION | OTHER | CPR/AED | 01 | AMERIAN HEART ASSOCIATION | OTHER |